Holistic Interventions Protocol for Interstitial Cystitis Symptom Control
A Case Study
Sylvia Kubsch, PhD, RN Suzanne M. Linton, MSN, APNP Christine Hankerson, MSN, RN
Harriet Wichowski, PhD, RN
Interstitial cystitis (IC) is a disabling bladder disorder that leads patients on an endless journey in search of
treatment options to control their painful symptoms. Although there are some medical treatments available, no one
treatment is completely effective. The Neuman model provides the rationale for the use of holistic prevention
interventions with IC patients. Holistic interventions can help IC patients to retain, attain, and maintain system
stability. A case study of 1 IC patient, who successfully used holistic approaches to achieve system stability, is
described. KEY WORDS: holistic,interstitial cystitis,intervention,Neuman Holist Nurs Pract2008;22(4):183–190
Author Affiliations:University of Wisconsin, Green Bay (Dr Kubsch); Pre
vea HealthUrology, Green Bay, Wisconsin (Ms Linton); Opis Management
Resources, LLC, Tampa, Florida (Ms Hankerson); and Marian College of
Fond du Lac, Wisconsin (Dr Wichowski).
The authors have no conflict of interest.
Corresponding Author:Sylvia Kubsch, PhD, RN, 2420 Nicolet Dr, Green
Bay, WI 54311 (kubschm@uwgb.edu).
Interstitial Cystitis (IC) is a chronic, debilitating,
and inflammatory disorder that affects the bladder
wall.1 The incidence of IC is approximately 847 000
people in the United States, which is 1 in 321 or
0.31%. Of those diagnosed with IC, about 700 000
(90%) are women. To date there have been few
epidemiological studies to identify more current
estimates.2–4 However, IC experts believe there may
be close to 25 to 30 million women affected simply
because of the complexity, underestimation, and
variability of diagnosis.2 The incidence of IC is similar
to that of Parkinson’s disease, that is, approximately 1
in 272 or 0.37% or 1 million people in United States.5
Yet, few people are as aware of the condition of IC
when compared with Parkinson’s disease.
Interstitial cystitis is a chronic disease manifested
by disabling pelvic, vaginal, and bladder pain, urinary
urgency, frequency, and nocturia. Interstitial cystitis
sufferers feel “chained” to their bathrooms, often
urinating 30 to 40 times a day, sometimes every 10 to
15 minutes. Urinating even a drop is the only way to
get relief from the pain. Symptoms are “invisible” and
frequently passed off as chronic urinary tract
infections, pelvic inflammatory disease, chronic
prostatitis, or endometriosis. For years IC was thought
to be a “psychosomatic disorder,” where women were
thought to exaggerate symptoms like was once felt
with premenstrual syndrome.6 Many patients suffer
for extended lengths of time because of inaccurate or
lack of a diagnosis.7 As a result, IC patients become
extremely frustrated and mistrust healthcare providers
as they search for answers to their years of suffering.
PATHOLOGY AND ETIOLOGY
The primary hypothesis for this chronic condition
suggests that there is a defect or weakness within the
bladder wall, specifically the inner epithelial lining of
the bladder or glycosaminoglycans (GAG).8 Normally,
this lining protects the bladder wall from the toxic
effects of the urine. Approximately 70% of IC patients
are thought to have a defective GAG layer, which
allows acidic urine to irritate the bladder wall, which
in turn can cause bladder, pelvic, and suprapubic pain.
Other hypotheses include autoimmune response,
increase of histamineproducing cells in the bladder
wall causing inflammation and engorgement of
tissue,8 defective nerve fibers within the bladder,
proteins in the urine, and infection.9–11
MAKING THE INTERSTITIAL
CYSTITIS DIAGNOSIS
To confirm the diagnosis and differentiate IC from
generalized cystitis, the urologist’s workup would
include urinalysis with culture, which typically reveals
no bacteria (or nitrates) but can demonstrate moderate
red blood cells and minimal white blood cells.11
The potassium sensitivity test may also be done to
detect problems with the bladder’s protective lining
(epithelium). The potassium sensitivity test is done by
instilling sterile water and then potassium chloride
into the bladder. If the patient feels pain and/or
significant urinary urgency during the instillations, the
test is considered positive, signifying that the bladder
lining is defective.12
Cystoscopy with hydrodistention is a procedure
done under anesthesia in the operating department,
which allows the urologist to visualize the inside of the
bladder. Cystoscopy may reveal erythematous areas to
the bladder’s surface epithelium, glomerulations
(pinpoint hemorrhages), bleeding fissures, and/or
scars. In 10% of IC patients, Hunner’s ulcers or
ulcerative patches surrounded by mucosal congestion
(on the dome or lateral walls of the bladder) are
present.11 Glomerulations and/or Hunner’s ulcers
become apparent after hydrodistension because
discreet areas of mucosal scarring rupture during the
procedure. Bladder biopsies will often show
inflammation without evidence of malignancy.
LITERATURE REVIEW
Medical treatment options
According to the literature on IC,the condition has no
cure; medical treatments offer only symptom control.
Urine cultures are negative, and patients may or may
not respond to antibiotics.11 Usually an array of oral
medications are tried in attempts to provide the patient
with symptom relief. These include pentosan
polysulfate (Elmiron), which has been shown to
actually repair the damaged lining of the bladder.11
Tricyclic antidepressants block pain receptors and
relax the bladder muscle. Antihistamines and
nonsteroidal antiinflammatory drugs, reduce the
amount of histamine within the bladder wall thereby
reducing inflammation.13 Antispasmodics and muscle
relaxants allow the bladder to hold more urine.
Phenazopyridine (Pyridium) is a urinary anesthetic
that decreases bladder spasms and urinary urgency.14
Calcium glycerophosphate (Prelief), TUMS, and
sodium bicarbonate have also been shown to be
effective in reducing foodrelated IC flares.13,15
Patients who do not respond to oral therapy may be
given bladder instillations (intravesical therapy),
where a variety of medications is instilled directly into
the bladder. This can be done weekly in the urology
office. One drug used along with hydrodistention is
dimethyl sulfoxide.11 Dimethyl sulfoxide passes into
the bladder wall, reduces inflammation, and prevents
muscle contractions that cause pain, frequency, and
urgency. However, it takes 6 to 8 instillations over a 3
to 4week period, for the patient to experience any
relief. Heparin sodium is another solution for
intravesical therapy, which is used for IC. Heparin is
instilled directly into the bladder and has both
antiinflammatory and surfaceprotectant properties. It
is thought that heparin mimics the bladder’s mucous
lining, temporarily “repairing” the GAG layer.16 The
procedure cystoscopy/hydrodistention can also
provide symptom relief for patients, as it increases the
bladder stretching capacity.
Lifestyle treatment options
Because it is known that acidic foods, reduced fluid
intake, smoking, “holding it,” and certain hygienic
practices can exacerbate IC Symptoms,10,13 making
simple lifestyle changes might reduce symptoms.
Patients should increase fluid intake to 6 to 8 glasses
of water (8 oz) a day and eliminate acidic trigger foods
such as citrus fruits, cranberries, grapes, chocolate,
cheese, yogurt, tomatoes, spicy foods, yeast, liver,
chemical additives, citric acid, sugar substitutes,
coffee/tea, carbonated drinks, and alcoholic
beverages.17 Patients should void on a regular basis
and should not hold it. They should also void before
and after sexual intercourse. Other recommendations
include wearing cotton undergarments, wiping
perineum from front to back, and avoiding douches,
tightfitting clothing, laundry detergents with
excessive additives, heavily perfumed soaps, bubble
baths, and hot tubs.10
Holistic treatment options
A few studies were found in the literature that
examined herbs and supplements aimed at treating
IC.6,16,18,19 Webster and Brennan6 found that a
combination of multiple vitamins, calcium/
magnesium supplements, and herbs reduced IC
symptoms in approximately 14% of the subjects
studied. Whitmore19 found that the Chinese herbs
cornus, garden rhubarb, Psoralea, and rehmannia,
decreased pain after 4 weeks in 61% of the subjects
studied (N=25). In 3 months, an additional 22% of
the subjects had a significant response. Another herbal
therapy that has been shown to be beneficial to urinary
tract and bladder health is the extract of pumpkin
seeds (cucubita pepo).18 The most consistent research
evidence is found for Gotu kola (Centellaasiatica)
and horsetail (Equisetumarvense).19 Gotu kola
enhances the integrity of connective tissue by
stimulating production of GAGs, which are essential
components of the mucous layer in the bladder.
Horsetail (Equisetum arvense) has astringent
properties.18
Bladder training is a therapy that inhibits the urge to
void by extending the interval between voidings. In
1 study, bladder training was successful in increasing
the voiding interval by 15 to 30 minutes every 3 to 4
weeks. In addition, 15 (71%) of the 21 IC patients also
noticed a decrease in nocturia, frequency, and
urgency.20 Intravaginal Theile massage for 6 weeks
significantly improved symptoms in 9 of 10 IC
patients.21
Moldwin22 noted that 76% of IC patients who used
mindbody therapies verbalized improvement in
urinary symptoms. Chaiken et al23 combined
relaxation audiotapes with pelvic floor exercises. Of
the 42 patients in their study, 71% showed a significant
increase in functional bladder capacity after 3 months
of relaxation and pelvic floor exercises, and 98% had a
significant decrease in the number of voidings per
day.23 Additional results of this same study23 showed
that music therapy improved the quality, depth, and
length of sleep in a significant number of IC subjects.
The slow and steady stretch used in hatha yoga has
been shown to relax pelvic floor muscles.24 Although
yoga is not a cure for IC, more than 90% of
participants who took an 8week course in yoga said
that it was helpful in reducing their IC symptoms,
including insomnia, mental, and emotional stress.24
Both acupuncture and acupressure have been shown to
diminish the pain and other negative side effects
associated with IC. According to Sandifer,25
acupressure applied to bladder meridians can restore
energy flow within the bladder. In a study of 14
patients, Rapkin and Kames26 found that 6 to 8 weeks
of acupuncture reduced the pain of IC. Lyons27
reported a case study of a 31yearold woman whose
IC symptoms were reduced with acupuncture to the
kidney and bladder meridians. The transcutaneous
electrical nerve stimulation unit placed on the lower
back or on the suprapubic region has been reported to
reduce the pain of IC.28 Carter and Weber29 have used
reflexology to relieve symptoms of the urinary tract.
THEORETICAL FRAMEWORK
The Neuman System’s Model30 supports the use of
holistic interventions that promote system equilibrium.
According to the model, when the flexible line of
defense is no longer capable of protecting the patient’s
system against the disruptive forces of IC,
intrapersonal, interpersonal, and extrapersonal
stressors related to IC break through the patient’s
normal rangeor responses, known as the normal line
of defense, causing IC symptoms to result. The major
concern of nursing, according the Neuman, is to help
the patient attain, maintain, or retain system stability.
This is done through primary prevention interventions
that strengthen the flexible line of defense, and thus
prevent stress and risk factors from entering the
system. Secondary prevention interventions are used
after a stressor has broken through the flexible line of
defense and caused a negative reaction. Secondary
prevention interventions focus on strengthening the
internal line of resistance through the treatment of
symptoms. Tertiary prevention interventions are used
after system stability has been reconstituted through
secondary prevention interventions and are aimed at
conserving energy and supporting existing strengths.
Relaxation therapy and meditation are examples of
primary prevention interventions for IC that can
strengthen the patient’s flexible line of defense
preventing stressors from entering the system. Guided
imagery, acupressure, and reflexology are examples of
holistic IC interventions that can assist IC patients to
eliminate distressing symptoms. Journaling and the
lived experience interview are viewed as tertiary
prevention interventions that help IC patients maintain
a state of wellness.
THE HOLISTIC INTERSTITIAL CYSTITIS
INTERVENTION PROTOCOL
As there is no cure for IC, even with the use of
medical treatments and lifestyle changes, it seems that
holistic therapies could be useful as they can help
patients cope with their condition and promote unity
and harmony of the mind, body, and spirit.
The condition of IC causes anxiety and is
exacerbated by stress and anxiety. The condition of IC
causes insomnia and is exacerbated by insomnia.
Holistic interventions are effective in reversing anxiety
and promoting sleep. Nurses are suitable healthcare
providers to implement holistic interventions because
nursing has traditionally had a holistic approach that is
expressed in nursing models such as Betty Neuman’s
Systems Model.15 Because nurses see IC patients for
an extended period of time in clinics and offices, they
are particularly appropriate to implement a holistic
plan. All this can be done in the clinic or office for no
additional cost to the patient.
The purpose of this article is to suggest a protocol
of holistic interventions for ICsymptom management.
The development of the holistic IC protocol adds to
nursing’s body of knowledge on holistic nursing
interventions. By using holistic interventions, nurses
can play a significant role in reducing or eliminating
the suffering of IC patients. The holistic interventions
used are in complement to the medical plan, not in lieu
of it. Mindbody therapies quiet the mind, take IC
patients’ mind off of their urgency symptoms, and
relax the musculature of the bladder wall. Energy
therapies unblock energy channels to the bladder.
Spiritual interventions provide a sense of hope and
impart meaning to their suffering.
Not all of the holistic therapies suggested in the
literature are incorporated into the protocol. Those
chosen were therapies that worked well together, were
possible for the patient to implement herself, and were
evidence based. The holistic ICintervention protocol
assumes continuation and compliance with
conventional medical approaches, as the combination
of approaches provides optimal patient results.
Consent
Collaboration with the patient’s physician and other
healthcare professionals in using holistic therapies to
treat IC is essential. The physician must know which
holistic therapies the nurse intends to use and how
they will work in complement with conventional
therapy. Ask the patient what holistic interventions
have been tried to reduce IC symptoms. If the patient
acknowledges any holistic interventions, explore the
therapies used and their effectiveness. Next, ascertain
whether the patient would like to learn additional
holistic interventions to help cope with and reduce IC
symptoms. If affirmative, inform the patient that
several therapies will be suggested and demonstrated.
Inform the patient that by accepting responsibility to
use holistic interventions, an active role on her part in
treatment will be assumed. Instruct the patient that
more than 1 holistic intervention may need to be used
to relieve the symptoms, and that there is no specific
order as to which holistic intervention is used first or
last.
Centering
Before utilizing the holistic ICintervention protocol at
the initial and all subsequent clinic/office visits, the
nurse should first center him or herself with healing
intention. To center one’s self, the nurse should close
his or her eyes, think only of the present moment, and
take several deep breaths focusing on exhalation and
diaphragmatic breathing.
Lived experience interview
The first holistic intervention to use with IC patients is
the lived experience interview.31 The lived experience
interview technique provides a comfortable place for
the patient to express experiences in living with the
condition of IC. To conduct such an interview, the
interviewer uses an unstructured openended
technique. The interview starts with a simple query
such as “Tell me what it is like to live with interstitial
cystitis.” From there the patient does most of the
talking taking the conversation “wherever.” The
interviewer should not direct the interview to a specific
topic, and occasionally utter encouraging phrases such
as “go on,” “tell me more,” etc. The effect of such an
interview validates the patient’s condition and
establishes a therapeutic healing relationship.
Journaling
Instruct the patient to keep a journal of the experience
of using holistic interventions to cope with and reduce
the symptoms of IC.32 Emphasize that journaling is a
map of selfdiscovery and insight; a reflection, not a
diary. Before journaling, the patient should stretch and
relax and clear the mind of any distractions. In each
entry the patient should write a personal reflection of
what motivated the use of a particular holistic
intervention and how effective it was. Acknowledge
what was learned and the accompanying emotions
while using the holistic intervention. Articulate the
effect of the intervention, both positive and negative.
Progressive muscle relaxation
Progressive muscle relaxation (PMR) can be used to
relax bladder musculature. A relaxed bladder will not
perceive every drop of urine as an urgent situation.
Progressive muscle relaxation involves the intentional
tightening and releasing of every muscle in the body,
one by one. When performing this technique, the
patient should pay special attention to tensing and
relaxing the abdominal and pelvic muscles. In the
shorthand PMR that follows, whole muscle groups are
simultaneously stimulated and then relaxed.33 Each
muscle group is tensed for 7 seconds and relaxed from
20 to 30 seconds.
1. Curl both fists, tightening biceps and forearms
(Charles Atlas pose). Hold. Relax.
2. Wrinkle up forehead. At the same time, press your
head as far back as possible, roll it clockwise in a
complete circle, reverse.
3. Now wrinkle up the muscles of your face like
a walnut: frowning, eyes squinted, lips pursed,
tongue pressing the roof of the mouth, and shoul
ders hunched. Hold. Relax.
4. Arch the back as you take a deep breath into the
chest. Hold. Relax.
5. Take a deep breath, pressing out the stomach and
pelvis. Hold. Relax.
6. Pull feet and toes back toward face, tightening
shins, Hold. Relax.
7. Curl toes, simultaneously tightening calves, thigh,
and buttocks. Hold. Relax.
Guided imagery
To distract, relax, and replace the negative images of
IC symptoms with positive images of healing, the
following script could be used. Close your eyes and
begin with three cleansing breaths, in a darkened, quiet
room. Imagine...it is a warm sunny day and you are
at your favorite beach, lying on your back in the warm
white sand, soaking in the warm sun and listening to
the waves crashing onto the shore. Imagine the feeling
of urinary urgency and suprapubic pressure you are
experiencing is being caused by several telephone
books sitting on your abdomen. Now imagine the
stack of telephone books being removed 1 at a time,
slowly they are removed, first one, then the second,
third, fourth, and the fifth. As each telephone book is
removed you feel less and less pressure. Finally, as the
last telephone book is removed, your suprapubic area
is free of pressure. Now imagine you are still at your
favorite beach, and it is getting even warmer. You are
holding a large delicious vanilla flavored softserve ice
cream cone. As you sit up eating the ice cream cone, it
starts to drip onto the warm sand. As you see the
vanilla ice cream drip onto the white sand, imagine,
the cone dripping into your bladder, drip, drip, drip. As
the ice cream drips into your bladder the drips coat the
bladder wall with cool refreshing cream. Your bladder
is now protected with the thick ice cream coating and
is pain free...as you lay back onto your beach towel
you rejoice in knowing your pain and urgency
symptoms are gone. As you open your eyes...you
are pleased to know that the beach is always going to
be there...and you can go back as often as you like.
Acupressure
A block in the flow of energy in the bladder results in
discomfort. Acupressure is a treatment that releases
blocked energy and promotes energy flow. To release
the blocked energy, the acupressure practitioner places
finger pressure on acupuncture points. The pressure
promotes energy flow to the bladder and alleviates the
sense of urgency and pain that occurs with small
amounts of urine in the bladder. Pressing on bladder
meridians also reduces some of the inflammatory
processes that occur in the bladder lining.25
After locating the bladder acupoints, press down
slowly to a level at which a certain resistance and a
little pain is felt. Press harder during expiration, and
relax pressure during inspiration. Repeat this process
at each bladder median several times.
To access bladder meridian 1, press the first and
second fingers into the inner corner of the lower
portion of the eye socket. With eyes closed work
around the lower portion of the eye socket from the
inner canthus to the outer canthus of eye pressing 5 to
6 times with 1 long expiration.25 Bladder meridians 4
and 5 are conveniently located at the temple hairline
area and straight behind on the top of the head. To
apply pressure to bladder meridian 10, place 1 hand on
top of the other, behind the neck, and using the heel of
the hand, apply pressure at the base of the skull.
Bladder meridian 11 can be accessed further down the
neck at the shoulder. The last acupoints to try if the
pain, pressure, and urgency persist are the lumbar area
bladder meridians 22, 23, 24, and 29 all located
1thumb distance from either side of the lower lumbar
spine. To apply acupressure to these bladder
meridians, stand up and bend over keeping the back of
the legs straight. Bring arms behind the back, and
place fists on the lower back on either side of the
spine. On inhalation, relax the pressure on exhalation,
and advance the pressure.25
Reflexology
Reflexology breaks up blockages in the energy,
circulation, and lymph systems allowing life energy to
flow freely to all parts of the body. The reflex points
are energy junctions that relay and reinforce energy
along meridian lines of the body passing energy
toward the organs and the nervous system. To clear the
energy pathways of the bladder, perform reflexology
on the soft spongy area next to the pad of the heel on
the inside of the foot.29 With the thumb, massage the
spongy areas on both feet, pressing several times.
Meditation
Mediation quiets the mind and promotes healing. It is
suggested that a form of ancient meditation called
“Jappa” be used.34 To use Jappa meditation, quiet the
mind by getting into a quiet space in the mind called
the “gap”. While in the gap, it is impossible to think
about the symptoms of IC. Both an affirmation and a
mantra will be used. The affirmation Hay35(p16)
suggests to counter bladder problems, “I comfortably
and easily release the old and welcome the new,”
makes a perfect affirmation to use while meditating.
One mantra often used in Jappa mediation is the
syllable “ah.” “Ah” is a universal sound in the word
God, no matter what language or religion.
To do Jappa meditation, sit in a comfortable chair,
feet flat on the ground, arms in lap, palms facing up,
make a circle with thumbs an index fingers touching,
close eyes, and take several deep breaths, focusing on
exhalation. Now start slowly saying Hay’s affirmation
1 word at a time. First, say the word “I,” and visualize
the word “I” on the blackboard in the center of your
forehead. Now visualize the word “comfortably.” Now
quickly jump back from the word “comfortably” into
the black space between the words “I” and
“comfortably.” This is the gap, experience it. While in
the gap, utter a mantra. Now continue to repeat each
word of Hay’s affirmation, 1 word at a time, going
ahead to the next word of the affirmation, jumping
back to the previous word, getting into the gap and
repeating the mantra out loud.
CASE STUDY
The notes from this case study relate the experiences
of 1 office nurse and 1 IC patient with their
permission. A 59yearold female patient sought the
help of her internist for insomnia. Despite therapies of
medications, diet restrictions, bladder washes, and
distensions, her troubling symptoms of recurring
pelvic pain, urgency, pressure, and the need to urinate
20 or more times a night continued. During the office
visit, the internist prescribed a tranquilizer to help her
sleep. He also provided some useful information on
lifestyle changes such as elimination of caffeine, not
“holding it,” and increasing intake of water to 6 to 8
glasses (8 oz) a day, and instructed the patient to make
a followup appointment in 1 week.
After the doctor left the examination room, the
patient complained to the office nurse, “I just wish
there was something that could help. I am so tired of
all of this.” At that point the nurse excused herself to
consult with the internist, gaining approval to suggest
holistic interventions to the patient. Returning to the
patient, the nurse asked the patient whether she would
be interested in learning some “holistic techniques” to
help control symptoms, the patient agreed.
Following consent, the nurse excused herself taking
a moment to center herself with the intention to heal.
Returning to the examination room, the nurse initiated
the “lived experience” interview. Noticeable relief of
stress was observed as the patient expressed “it is good
to tell someone about this who believes me.” The
nurse instructed the patient to keep a journal of the
events that would occur in the next couple of months
as holistic therapies were tried. Next the nurse
instructed the patient how to do PMR, guided imagery,
acupressure, reflexology, and meditation. She
provided the patient with handouts and audiotapes of
the interventions, which had appropriate therapeutic
music background.
At the next office visit, the patient reported, “It’s the
same every night. I wake up about 2 AM and have to
urinate. I get up, go back to bed, and in about 10
minutes up again, then back to bed, the urgency gets
worse, continues, with its burning, pressure, getting up
every five minutes for about two hours. When that
happens, I realize that once again I am in the cycle of
the IC condition. Over this past week I decided to try
the ideas you provided. Since I was half asleep, the
easiest one for me to do was the eye socket and
hairline acupressure. I lay back on the pillow and did
the technique as you instructed, pressing my fingers
from the center of the lower eye socket to the outer.
While I noticed some relief, I had to soon ‘go’ again
so I decided to listen to the guided imagery script of
the beach using the audiotape you provided. As I
listened to your comforting voice and the sound of the
waves, I imagined the vanilla soft serve ice cream
dripping into my bladder and I actually felt some relief
and fell asleep for a while. It was about an hour before
I awoke again. This time after returning to bed, I tried
the reflexology, pressing the soft spongy tissue inside
both heels. I guess it worked as the next time I awoke
it was 7 AM. In the evening of the second day I
recorded these events and my feelings in my journal.
On the second night, it was the same old thing, up at
2 AM with pressure and urgency. After returning to bed
I thought I would use ankle reflexology first since it
was so effective the night before, but only experienced
a little relief. This time, I tried progressive muscle
relaxation using your tape. Although I enjoyed the
classical music background, it was harder to do than
the imagery, as it took a lot of concentration. I think I
was up another five times to the bathroom, but finally
got to sleep. The next day I thought I should try one of
the interventions before I went to sleep so I put on the
meditation tape. It was easy to do Jappa meditation
with your voice coaching me. I dozed off and slept
until 4 AM; after I woke up and urinated, I tried the eye
socket adding hairline reflexology. This technique
stopped the pain and urgency for another 2 hours and
by then it was time to get up. I think a combination
of them is effective. As the nights go on, I use a
variety of them in different sequences. At least I feel
that in some way I am taking control of my condition
now.”
CONCLUSION
Additional research needs to be conducted to
determine the effectiveness of the suggested holistic
intervention protocol in a larger population. This case
study provides only anecdotal evidence but shows
promise in the effectiveness of holistic interventions to
relieve the symptoms of IC. In the case study, the
holistic interventions of PMR and meditation
prevented the escalation of IC symptoms and
prevented the reaction to the stress of IC from
penetrating the system. The secondary prevention
interventions of acupressure and reflexology acted to
reduce symptoms by unblocking and balancing
energy channels, thus normalizing the central core.
The lived experience interview and journaling
supported existing strengths and maintained system
stability.
It is evident that a combination of conventional and
holistic therapies is most beneficial for reducing the
irritating symptoms the IC patient endures. A
knowledgeable nurse can employ the holistic
intervention protocol and support the IC patient
through this process.
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